The doctor will ask about your symptoms and medical history, and perform a physical exam. The cause of a headache can be difficult to determine. The doctor will ask about the frequency and pattern of your headaches. To help provide answers, keep a diary of:

When your headaches start and end

What you were doing at the time

What you did to try to relieve pain and how effective the treatment was

Family members with the same condition

Triggers that you are aware of

Where the pain is located and where it spreads to

Other symptoms associated with the pain

Tests to determine the cause of headaches include:

Neurological exam—The doctor may perform a neurological exam to assess:

Muscle strength

Coordination

Reflexes

Sensation

Mental status

Cranial nerve function

Blood tests—Blood tests may be done to exclude other causes of your headache. These include
blood sugar
, a
complete blood count
looking for
anemia
or infection, as well as other studies to potentially look for evidence of inflammation.

X-rays
—X-rays of the neck may help determine if arthritis is contributing to a tension headache. Skull x-rays may be taken to check for structural changes responsible for
sinusitis
.

CT scan
—This is a type of x-ray that uses a computer to make pictures of structures inside the head. A CT scan is used to check for conditions that may cause headaches or to determine if a structural problem is causing chronic sinusitis.

MRI scan
—This is a test that uses magnetic waves to make pictures of structures inside the head. An MRI scan can be used to check for any conditions (
tumor
or bleeding in head) that may be responsible for your headaches.

Nasal endoscopy—The doctor uses a thin, lighted tube to look inside your nose and possibly take samples of drainage to be tested for
allergies
or infection.

Lumbar puncture
(LP, spinal tap)—During this procedure, spinal fluid is collected to look for bleeding, infections, or cancer.
The opening pressure may also be measured.

Often, tests are done to rule out causes of your headaches.

References

Guidelines for All Doctors in the Diagnosis and Management of Migraine and Tension-Type Headache
.
2nd ed. London, UK: British Association for the Study of Headache (BASH); 2004.

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